Improving Preterm Outcomes by Safeguarding Maternal Mental Health

通过保障孕产妇心理健康改善早产结局

• 批准号: 8690931
• 负责人: Michael Silverstein
• 金额: $ 61.27万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-05 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8690931
• 关键词: Academic Medical Centers; Address; Adherence; Behavioral; Biological; Boston; Caregiver Burden; Caring; Child; Child Behavior; Child Development; Code; Cognition; Cognitive; Complex; Cues; Development; Education; Emotional; Face; Family; Fostering; Funding; Goals; Growth; Health; Hospitalization; Incidence; Infant; Institute of Medicine (U.S.); Intervention; Lead; Life; Low income; Massachusetts; Measures; Mediating; Medical center; Mental Depression; Mental Health; Modeling; Modification; Mother-Child Relations; Mothers; Neonatal Intensive Care Units; Outcome; Outcome Measure; Parenting behavior; Perception; Population; Postpartum Period; Premature Birth; Premature Infant; Prevention strategy; Problem Solving; Public Health; Quality Indicator; Randomized Controlled Trials; Recording of previous events; Reporting; Risk; Series; Severities; Social Work; Social isolation; Stress; Symptoms; Training; Trauma; Videotape; Work; base; depressive symptoms; effective intervention; evidence base; experience; follow-up; improved; improved functioning; innovation; maternal depression; novel; pilot trial; post-traumatic stress; postnatal; prevent; randomized trial; selective prevention; single episode major depressive disorder; skills; social; therapy design

DESCRIPTION (provided by applicant): Preterm infants are born at biological risk for poor health and developmental outcomes; maternal depression is disproportionately common among this population, and is known to exacerbate these outcomes. In its 2006 report, Preterm Birth, the Institute of Medicine stated the public health importance of optimizing the developmental outcomes of preterm infants, and specifically called for novel postnatal intervention strategies to accomplish this goal. This R01 application is based on the premise that preventing maternal depression and optimizing maternal functioning will ultimately improve the developmental outcomes of preterm infants. It follows the successful completion of an R03-funded pilot trial of Problem Solving Education (PSE) among mothers of preterm infants in two neonatal intensive care units (NICUs). PSE is a cognitive behavioral strategy that aims to impart recipients with skills to reduce the impact of stress on personal functioning, and thereby prevent depression. We now propose a randomized trial of a tailored intervention - NICU-PSE - which augments the core pilot model with brief motivational strategies to maximize intervention adherence, and devotes three of six intervention sessions to specific challenges faced by families of preterm infants, identified in the pilot: caregiver burden, navigating complex infant follow-up services, and social reintegration of the family following prolonged infant hospitalization. We will conduct an RCT of 325 low-income mothers with preterm infants in three NICUs - Boston Medical Center, Tufts Medical Center, and University of Massachusetts Medical Center. Over 12-months of follow-up, we will assess the effects of NICU-PSE on a series of outcomes measures for mothers of preterm infants, and a series of measures that represent specific risk mechanisms by which maternal depression is theorized to impact young children. Specifically, we aim to decrease the incidence of major depressive episode and improve depressive symptom trajectories; and improve general and parental functioning. We also aim to improve adherence to evidence-based quality indicators for NICU follow-up care; improve mothers' perceptions of mastery, and decrease their perceptions of caregiver burden and social isolation; and improve mothers' sensitivity to infant cues. Through our intervention, we hypothesize that mothers of preterm infants will develop stronger problem solving skills and perceive less stress. This will lead to a decreased burden of depressive symptomatology. Intervention mothers will also experience improved functioning, manifested in better adherence to NICU follow- up care, and decreased perceptions of caregiver burden and social isolation. NICU-PSE is a replicable intervention, designed to be delivered within two to four months of preterm delivery by bachelor level practitioners without extensive training. Our ultimate goal is to disseminate a safe and effective intervention applicable to all low-income families with preterm infants.

描述（由申请人提供）：早产儿出生的健康和发展结果的生物学风险；孕产妇抑郁在该人群中不成比例，并且众所周知会加剧这些结果。该研究所在2006年的报告《早产》中指出了公共健康的重要性，优化了早产儿的发展成果，并特别呼吁采取新颖的产后干预策略 实现这一目标。此R01应用是基于这样的前提：预防母体抑郁和优化母体功能最终将改善早产儿的发育效果。这是在两个新生儿重症监护病房（NICUS）中成功完成了R03资助的解决问题教育（PSE）的R03资助的试点试验。 PSE是一种认知行为策略，旨在授予接受者的技能，以减少压力对个人功能的影响，从而防止抑郁症。 We now propose a randomized trial of a tailored intervention - NICU-PSE - which augments the core pilot model with brief motivational strategies to maximize intervention adherence, and devotes three of six intervention sessions to specific challenges faced by families of preterm infants, identified in the pilot: caregiver burden, navigating complex infant follow-up services, and social reintegration of the family following prolonged infant hospitalization.我们将在三个NICUS，波士顿医疗中心，塔夫茨医学中心和马萨诸塞大学医学中心的三名NICUS中，由325位低收入母亲组成325个低收入母亲。在超过12个月的随访中，我们将评估NICU-PSE对早产儿母亲的一系列成果措施的影响，以及一系列代表特定风险机制的措施，从理论上讲，孕产妇抑郁症会影响幼儿。具体而言，我们旨在减少重度抑郁发作的发生率并改善抑郁症状轨迹；并改善一般和父母的功能。我们还旨在提高对NICU随访的基于证据的质量指标的依从性；提高母亲对掌握的看法，并减少对照料者负担和社会孤立的看法；并提高母亲对婴儿提示的敏感性。通过我们的干预，我们假设早产儿的母亲将发展出更强的解决问题技能，并降低压力。这将导致抑郁症状的负担减轻。干预母亲还将经历改善的功能，表现为更好地遵守NICU跟进，并减少对照料者负担和社会隔离的看法。 NICU-PSE是一种可复制的干预措施，旨在在没有广泛培训的情况下由单身汉级从业者在早产后的两到四个月内交付。我们的最终目标是传播适用于所有早产儿的所有低收入家庭的安全有效干预措施。